Capital Improvement ProgramHRSA-09-244
Electronic Health Record Projects and Readiness
May 7, 2009
May 2009 2
CIP Funding
• $850M one-time, 2-year project/budget period FY 2009 grants to support
• Construction• Renovation and equipment• Acquisition of health information technology
• Grantees must• Demonstrate improvements in access to health services for the underserved
populations• Create health center and construction-related jobs
• 2-Year project/budget period (July 1, 2009 – June 30, 2011)
• Maximum funding based on CY 2008 UDS Data Formula• All section 330 grantees eligible for $250K base amount• Plus $35 per patient served based on 2008 UDS as of 04/24/2009• New Start grantees without 2008 UDS data will have $250K maximum
May 2009 3
CIP Funding, part 2
• CIP guidance available: May 1, 2009
• One-time award for 2-year budget/project period
• No on-going funding anticipated
• Grantees will only be submitting one CIP application
• Grantees may propose more than 1 project
• Grantees will submit applications/requests through EHB
• Applications due no later than: June 2, 2009 8:00PM ET
• EHB-generated email• Eligibility code• Maximum eligible budget amount• Sent to all eligible Health Center Program grantees on May 2, 2009
• Electronic application available: May 4, 2009
May 2009 4
Types of CIP Projects
• The eligible project types are:1. Alteration/repair/renovation, with or without
IT/equipment
2. Construction (new site or expansion of existing site), with or without IT/equipment
3. IT/equipment-only purchase
4. HIT-only purchase (non-EHR equipment)
5. Certified EHR-related purchase
May 2009 5
Ineligible CIP Costs• Operating costs (e.g., funding direct services, clinical full-time
equivalents, rent, mortgage payments, refinanced credit facilities).
• Purchase of EHR systems that are not certified by an organization recognized by the Secretary of HHS.
• None of the funds appropriated or otherwise made available under the Recovery Act may be used by any State or local government, or any private entity, for any casino or other gambling establishment, aquarium, zoo, golf course, or swimming pool.
• Non-certified EHR systems can not be listed as other equipment.
• Costs incurred prior to February 17, 2009.
May 2009 6
Certified Electronic Health Record (EHR)
Computer software that providers use to track all aspects of patient care
Health Information Technology (HIT)
Includes hardware, software, integrated technologies or related licenses, intellectual property, upgrades, or packages solutions sold as services that are designed for or support the use by health care entities or patients for the electronic creation, maintenance, access, or exchange of health information.
! For CIP, allowable costs include pre-implementation and readiness, software, infrastructure/clinical facility, data center infrastructure, and implementation staffing.
EHR and HIT
May 2009 7
Allowable use of funds
Certified Electronic Health Record (EHR)
• Certified EHR software costs: EHR application costs, maintenance, computer-based training
• Infrastructure clinical facility costs: wireless LAN infrastructure, LAN switches, tablets, desktop PCs, cameras, printers
• Data infrastructure costs: servers, routers, switches, back-up software, fire suppression, cooling/HVAC, physical security, power upgrades
• Implementation staff: core team training, vendor project management, data migration, paper chart conversion, CIO, network administration
Health Information Technology (HIT)
• Telehealth-related equipment• Registries• Electronic prescribing• Enhancements necessary to interface
between HIT/EHR and other electronic systems
• Dental and oral health
! HIT–only (non-EHR equipment) and certified EHR-related purchases can be proposed either as site-specific, multi-site, or organization-wide (inclusive of all sites).
May 2009 8
EHR Considerations
• Grantees are encouraged to work with others who have successfully procured, adopted, and used certified EHRs and other HIT systems, and to use up to 2% of the CIP project budget for HIT and certified EHR implementation technical assistance.
• In regards to EHR-related purchases, health center grantees within the scope of a current HRSA-funded health center controlled network are encouraged to work with their network to enhance their existing system.
• If EHR-related equipment will require significant installation, the grantee should propose an a/r/r or construction project to account for the installation of any fixed equipment. The grantee should also propose a separate EHR project to account for the purchase of all related EHR components.
May 2009 9
Electronic Health Records
All EHRs must:• Be certified by an organization recognized by the
Secretary of HHS– Certification Commission for Healthcare Information Technology
(CCHIT)• http://www.cchit.org
– Any EHR certified by CCHIT is eligible
All health centers must:• Demonstrate readiness
– Complete the EHR Readiness Checklist in Appendix 5 (pg 33) of the guidance
• Certify immediate readiness for certified EHR purchase, OR• Certify purchase of the certified EHR system will occur once
readiness is achieved within the 2-year project period
May 2009 10
EHR Planning and Readiness Process
• Identify goals for the EHR project• Create a strategic plan that guides
the certified EHR procurement and identifies key milestones to achieving “meaningful use”
• Include a completed feasibility analysis
• Include a completed comprehensive organizational readiness assessment
• Include a completed comprehensive staff skills assessment
• Assess and inventory current resources (staff, hardware, software, etc.)
• Outline an implementation strategy for the EHR project that will achieve “meaningful use”
• Inventory all additional hardware, software, and staff expertise needed to implement the EHR project
• Identify a multidisciplinary committee to oversee the readiness, due diligence, selection, and implementation of the certified EHR project
• Identify a plan to address the decrease in productivity during training and implementation
• Develop a plan to protect patient’s health information
! EHR Planning and Readiness information can be found at http://www.hrsa.gov/healthit/
May 2009 11
Electronic Health Records Caveats
• CIP funds cannot supplant HRSA funds that have been allocated for certified EHR-related activities (i.e., other HRSA grants that have been awarded to health center controlled networks for certified EHR adoption).
• Purchase of EHR systems that are not certified by an organization recognized by the Secretary of HHS are not allowed. At this time, CCHIT is the only recognized certifying organization.
• Grantees may not add a new site as part of certified EHR-only projects, although they may propose that these types of projects occur at a site added previously as part of an alteration/repair/renovation or construction project in the same application.
• Grantees must demonstrate readiness to purchase a certified EHR system prior to expanding CIP funds.
• If readiness gaps exist, grantees will need to certify that a certified EHR purchase will occur once readiness is achieved within the two-year period. For, applicants that cannot certify readiness to purchase a certified EHR system within the project period, EHR system costs are not eligible uses of CIP funds.
May 2009 12
EHB Specifics—EHR Readiness Checklist 1. Why are you purchasing a certified EHR or enhancing your current system? (Please check one)
[_] Move from paper system to electronic[_] Reimbursement purposes, e.g., Medicare and Medicaid incentive payments[_] Clinical technology to achieve workflow efficiencies[_] Primarily as a technology to enable quality care improvement goals
2. Do you have organizational wide commitment from: (Check all that apply)
[_] Leadership (CEO, COO, CMO, CFO)[_] Board Members[_] All Providers[_] IT Staff[_] Support Staff[_] Other; please identify:_________________________
3. Has your center identified business and clinical goals for adopting a certified EHR system?[_] Yes [_] No
4. Has your center identified a clinical champion and other staff to oversee the readiness process?[_] Yes [_] No
5. Have you used the EHR Selection Guidelines for Health Centers developed by HRSA to select the functionality for your EHR?[_] Yes [_] No
6. Have you considered the ongoing expenses required for a certified EHR system?[_] Yes [_] No
7. Are all key staff members willing to use computers in their daily work?[_] Yes [_] No
8. Do you have IT staff or access to a Health Center Controlled Network or IT consultant to provide support for troubleshooting your current and proposed IT/HIT infrastructure? [_] Yes [_] No
9. Do the exam rooms in your center have networked computers?[_] Yes [_] No
10. Does your center have a broadband/high speed internet connection?[_] Yes [_] No
May 2009 13
Electronic Health Records Caveats—cont.
• For any contract, grantees will need to make sure they follow the standard procurement principles that apply to all HHS grants.
• If the project budget obligates money beyond 25% of the combined budget for all projects or $250,000, the change of scope will need to be reviewed and possibly changed.
• All procurement must comply with HHS 45 CFR Parts 74.34 and 92.32.– “In order to ensure objective contractor performance and eliminate unfair
competitive advantage, contractors that develop or draft grant applications, or contract specifications, requirements, statements of work, invitations for bids and/or requests for proposals shall be excluded from competing for such procurements.”
(http://www.access.gpo.gov/nara/cfr/waisidx_07/45cfr74_07.html.)
May 2009 14
Environmental Information and Documentation (EID) Checklist
• Must be completed and submitted with EACH project (applies to all project types) as part of the CIP application.
May 2009 15
EHR/HIT Specific Form 424C Line Items
• Costs in Line 1 (Administrative)– Personnel costs should be explained by listing each staff
member who will be supported from funds, name, position title, percent full time equivalency and annual salary
– Travel of staff for trainings on EHR/HIT system – Subcontracts and justifications, provide an explanation as to the
purpose of each contract and how the costs were estimated– Pre-implementation/Readiness costs—including but not limited to
workflow assessment, change management, planning for loss of staff productivity, communication and training for patient involvement.
– EHR/HIT support, maintenance– Consultation and technical assistance costs
May 2009 16
EHR Specific Form 424C Line Items
• Costs in Line 10—EHR acquisition/implementation costs:– Software Costs: EHR/HIT Software costs, operating systems,
Help desk application, computer based training, EHR/HIT web portal, and other software
– Infrastructure Clinical Facility costs may include: Wireless LAN infrastructure, LAN switches (closets), routers, tablets, table docking stations, tablet batteries (spare), tablet keyboards, docking racks, desktop PCs, scanners, patient ID card systems, patient ID card readers, cameras, network printers, cabling-access points, network transport link to data center
– Data Center Infrastructure Costs may include: servers, applications, database, reporting, routers, core switches, desktop switches, data replication, AN-applications, database, reporting, SAN-document management, backup library, backup software, firewall anti malware, server racks, space acquisition, power upgrades, UPS, fire suppression, cooling/HVAC, management consoles, back up media, fax server, etc.
May 2009 17
Project Impact and Reporting
• Application projections– Projected number of providers using the certified EHR or
enhanced HIT system as a result of this project– Projected number of patients with an electronic health record as
a result of this project
• Impact of CIP funding– Number of new/improved sites– Number of health center jobs created and retained– Number of construction-related jobs created – Completion status (% complete)– Actual versus projected budget information—uses of CIP grant
funds
• Other ARRA reporting required by Act
May 2009 18
Resources for Planning and Implementing Certified EHR
Projects
May 2009 1919
HRSA’s HIT Goals
• Bring HIT to America’s safety net providers which will – Improve quality of care– Reduce health disparities – Increase efficiency in care delivery systems– Increase patient safety– Decrease medical errors – Eliminate the digital divide
May 2009 20
HIT is…..
• Health Information Technology is the use of information and communication technology in health care. Health Information Technology can include:– Electronic health or medical records – Personal health records – E-mail communication – Clinical alerts and reminders – Computerized decision support systems – Hand-held devices – Other technologies that store, protect, retrieve and transfer
clinical, administrative, and financial information electronically within health care settings.
• HHS/HRSA/Health Information Technology
May 2009 21
The Cycle of Health IT ImplementationThe Cycle of Health IT Implementation
May 2009 22
How to start?
• Planning Phase– Needs assessments and technology selection– Stakeholder buy-in– Funding and sustainability strategy– RFP process
• Implementation Phase– Vendor selection process– Implementation team organization– Sites for go-live– Cost issues
• Evaluation– Measure outcomes– Change strategies
May 2009 23
Needs Assessments
• Needs Assessments– Document processes that are inefficient
• Do not automate a manual process that does not work—change the process
– Understand how technology solutions can solve these inefficiencies:
• Need for data integration from many sources• Need to deliver data to many locations
• Tools– HRSA Readiness Assessment Tool
• http://healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_1248_227915_0_0_18/ehrguidelines.doc
– CHCF Needs Assessment Tool• http://www.communityclinics.org/section/library/?topic=2
May 2009 24
HIT Planning Considerations
• Data & Technical Standards
• Interoperability
• Certification by certification body that is recognized by the Secretary of HHS– Certification body for electronic health records
and their networks, and an independent, voluntary, private-sector initiative
May 2009 25
What EHR should I choose?
• Do not start in “product selection mode”• Begin by identifying the practice processes that you wish
to improve first; understand your work flow.• Then search for the functions you need:
– Problem List– Medications– Clinical Encounters– Lab/X-ray/Pathology– Telephone Calls– Referrals– Preventive Care– Managed care
May 2009 26
Advancing HIT through Networks
• Why Networks?– Collaboration of health centers and other
safety net providers– Economies of scale/cost efficiencies/volume– Enhanced efficiencies in business and clinical
core areas– Higher performance and value– Sharing of expertise and staff among
collaborators
May 2009 27
Which EHR should I choose?
• Anticipate primary and secondary users– Primary
• Clinical decision making• Documentation• Support for billing• Quality improvement
– Secondary• Provider profiling and service utilization• Quality report cards and outcomes analysis• Regulatory reporting and justification for studies
May 2009 28
Lessons Learned
• Involve clinicians
• Identify organization’s need and how HIT adoption will address this need
• Integration takes time; move forward but deliberately
• Identify roles and responsibilities, expectations, goals, and resources such as technical assistance
• Learn from early adopters such as Health Center Controlled Networks or other Health Centers (most are willing to share) and consider partnering with them
May 2009 29
Lessons Learned (cont’d)
• Conduct due diligence with all purchases
• Look for small, incremental successes
• Set and maintain realistic expectations and goals
• Communication must be open, consistent, and include all partners and staff. Establish feedback loops throughout the process.
May 2009 30
HIT Technical Assistance Center (HITTAC)
• Overview—Provide consistent HIT TA to HRSA grantees and staff– One-to-many TA– One-on-one TA
May 2009 31
HITTAC: One-to-Many TA
• HRSA Health IT Community
• HIT Toolboxes
• HIT Webinars
• HIT Workshops
May 2009 32
HRSA Health IT Community Portal
• HRSA Health HIT Community Portal– Developed in collaboration with the AHRQ National
Resource Center for Health IT (NRC)– Designed to provide news, tools, and access to
research for HRSA's safety net providers interested in health IT.
– Includes a searchable internet database that contains literature articles about the costs and/or benefits of health information technology
– Request log on password: [email protected]– Log in to the Portal: http://healthit.ahrq.gov/login
May 2009 33
• Developed by Health Resources and Services Administration
• Compilation of planning, implementation and evaluation resources
• Helps community health centers, other safety net and ambulatory providers implement health IT applications
• Organized to support needs of stakeholders ranging from senior management to the staff implementing health information systems
• Provides information regarding implementing applications such as disease registries, electronic health records, etc.
• Various stakeholders in the health IT arena have reviewed and contributed to the toolbox to ensure accurate, relevant, and effective in supporting health IT in health centers
• Toolbox made publicly available in November 2008 and can be accessed at:
– http://healthit.ahrq.gov/toolbox
Introduction to the Health IT Adoption Toolbox
May 2009 34
HIT TA Toolboxes/Modules
• Overview on why we create toolboxes– Current Toolbox
• Health IT Adoption Toolbox– Upcoming Toolboxes
• Rural Health• Telehealth• Children’s Health IT Toolbox
– Upcoming Modules• Network Development• Personal Health Records• e-prescribing• Quality through HIT
May 2009 35
Toolbox Topic-Specific Modules
• The toolbox is organized into the following eleven modules: – Introduction to Health IT – Getting Started – Opportunities for Collaboration – Project Management and Oversight – Planning for Technology Implementation – Organizational Change Management and Training – System Implementation – Evaluating, Optimizing, and Sustaining – Advanced Topics – Open Source and Public Domain Software– Privacy and Security
May 2009 36
HITTAC One-to-Many TA
• Webinars– HRSA holds monthly webinars on various HIT-
specific topics– Webinars are all archived: http://
healthit.ahrq.gov/login– A password and log in is required to access
the portal. To obtain this, email the request to [email protected].
May 2009 37
HITTAC One-to-Many TA Webinars
• Over 3,000 HRSA grantees and staff have participated in a wide range of webinars including:– HIT 101
– Important Factors to Consider When Selecting an EHR System
– Collaboration (How do I collaborate with networks, state entities, etc.)
– Telehealth 101
– Financing HIT
– Readiness Assessments for HIT
– HIE 101
– HIT for Special Populations
– Using EHRs to Drive Quality Improvement
– Personal Health Records
May 2009 38
HITTAC One-to-Many TA Webinars cont.
• Upcoming Webinars:– May 2009 – HIT and Sustainability for Rural
Settings– June 2009 – Due Diligence – What is it? Why
should I do it?– July 2009 – Disaster Recover Plans for HIT– August 2009 – Public Health Informatics
May 2009 39
HITTAC One-to-One TAConsultation with OHIT Staff
• OHIT encourages HRSA grantees and staff to call or email with any HIT questions– Can you help me identify other grantees using
the same software that I am using or looking to implement?
– My grantee has a question on HIT I cannot answer—can you assist us?
• You may contact us a [email protected]
May 2009 40
Overview of the CIP Application in the EHB
May 2009 41
CIP ApplicationProgram Specific Information
• This diagram shows the structure of a Capital Improvement Program application, using the left side menus from the EHBs.
• The application has one Program Specific Information section that includes one or more projects.
• Project forms need to be completed for each proposed project.
• Multiple projects can be proposed within a single application.
Complete Application
Program Specific Information
Project #1
Project #2
Project #3
May 2009 42
Program Specific InformationProposal Cover Page
4 Sections:
1. Purpose2. Sustainability Plan3. Green/Sustainable
Design Principles4. Service Impacts
• Projected # additional Provider FTEs• # additional patients served• # of additional visits
Service Impacts
May 2009 43
Program Specific InformationProjects
Add Project button
Update or Delete a Project
Application Budget Summary
Information
May 2009 44
Program Specific InformationAdding a Project
Choose a project type from the list If you select and confirm the wrong project type, you will not be able to change it. You will
have to delete the project from the application and start over. Enter a project title.
May 2009 45
Program Specific InformationAdd Project Confirmation
Certified EHR-related purchase
EHR Project
May 2009 46
Program Specific InformationProjects—Status Page
• Each project consists of numerous sections.• Each project has its own Status page.• Click the “Update” link in the Project Status table to
open a section for editing.
May 2009 47
Project InformationProject Cover Page
1. Site Information2. Project Management3. Contact Information4. Need5. Implementation6. Timeline
Standard Sections:
EHR-specific section:7. EHR System Readiness
May 2009 48
Project InformationProject Cover Page—EHR System
Readiness
Download and Attach EHR Readiness
Checklist Template(see next slide)
EHR Readiness Certification
May 2009 49
Project InformationEHR System Readiness Checklist
1. Why are you purchasing a EHR?2. Do you have staff commitment?3. Do you have business and clinical
goals?4. Do you have a clinical champion?5. Did you use HRSA’s EHR Selection
Guidelines?
May 2009 50
Project InformationProject Impact
Direct Impacts indicated in terms of:
• Square feet improved• Square feet increased• # of providers using the EHR or HIT• # patients with EHR
Projected FTEs
May 2009 51
Project InformationEquipment List
Click to Add Equipment
Select Desired line firstto Update or Delete
May 2009 52
Project InformationAdd Equipment Information
Select from 3 Types of Equipment:• Clinical• Non-clinical• HIT/EHR
May 2009 53
Project InformationProject Budget
Subtotalscalculated by system
These Totals carried over to Funding form
(see next slide)
Application Budget Summary
Information
May 2009 54
Project Information Funding Sources
These Totals carried over from
Project Budget form
May 2009 55
Project Information Budget Justification
Budget Justification is an attached
document
May 2009 56
Project Information Form 5B: Sites
Pick Sites from current Scope of Project
“Grantees may not add a new site as part of an IT/equipment-only, HIT, or certified EHR-related project, although they may propose that these types of projects occur at a site added previously as part of an alteration/repair/renovation or construction project in the same application.” (CIP Announcement HRSA-09-244 pages 3-4)
By default the completion status of the site is marked as COMPLETE for sites picked from scope. You will not be allowed to update any information for such sites in the CIP application.
Add Sites proposed in CIP A/R/R or Construction Project
May 2009 57
Project Information Attempting to Add a Site for an EHR
Project
May 2009 58
Project InformationForm 5B: Sites, Select from Scope
Site Name 1
Site Name 2
Site Name 3
Site Name 1 Address
Site Name 2 Address
Site Name 3 Address
When picking a site from scope, simply select the site, and then click “Save and Continue.”
May 2009 59
Add Site Checklist and Other Requirements for Sites are not required for EHR Projects
The Add Site Checklist page is only required for A/R/R, Construction and IT/Equipment-only Purchase projects
where the applicant is proposing to add a new site.
May 2009 60
Project InformationEID Checklist
EID Checklistis a
downloadable Template
… that must be attached
May 2009 61
Help ResourcesResource Type Purpose
https://grants.hrsa.gov/webexternal/home.asp Website HRSA Electronic Handbooks URL.
Call the HRSA Call Center at
877-Go4-HRSA/877-464-4772; 301-998-7373(9:00 AM to 5:30 PM ET M-F)
E-mail: [email protected]
Phone and/orE-mail
System help by phone or via e-mail. Do not use this for program questions.
Call the BPHC Help Desk at
1-301-443-7356(8:30 AM to 5:30 PM ET M-F)
E-mail [email protected]
Phone and/orE-mail
Program help by phone or e-mail.
There will extended hours of operation for the CIP initiative beginning May 30 and ending June 2, 2009.
For these dates the hours of operation will be 7:00 AM to 7:00 PM (ET)
May 2009 62
CIP Application Technical Assistance
Frequently Asked Questions
http://bphc.hrsa.gov/recovery/
Health IT Adoption Toolbox
http://healthit.ahrq.gov/toolbox
Sustainable and Green Design
http://www.usgbc.org http://www.gghc.org
Equipment http://www.epeat.net http://www.energystar.gov
May 2009 63
CIP Contacts
Type of Assistance Needed Please Contact
Business, administrative, or fiscal issues related to this announcement
Health Resources and Services AdministrationOffice of Federal Assistance ManagementDivision of Grants Management Operations
Neal Meyerson, Telephone: 301-443-5906; Email: [email protected]
LaShawna Smith, Telephone: 301-443-4241; Email: [email protected]
Program issues Health Resources and Services AdministrationBureau of Primary Health CareOffice of Policy and Program Development
Marie Legaspi, Telephone: 301-594-4319Meghan Ochal, Telephone: 301-594-2096Beth Tchinski, Telephone: 301-443-1389Email: [email protected]